Judy Pitts

Environmental exposures and family history of asthma.

Abstract Background: Asthma pathogenesis is a complex interaction of genetic, ethnic, environmental and social/life style risk factors. Aim: The goal of this study was to identify associations, if any, in children with asthma, between environmental risk factors (exposure to second-hand tobacco smoke (STS), pet ownership, race and a family history of asthma. Methods: After IRB approval, from June 2011 to December 2014, 823 children with asthma were enrolled in this prospective cross sectional study. At the initial visit, families completed a questionnaire with information on family history of asthma, having a pet at home and exposure to STS by parents at home. Chi square analyses were calculated, with alpha level of significance ≤0.05. Results: History of asthma in parents, siblings or grandparents was reported by 575 (69.8%) patients including father (n = 154, 17.8%) and mother (n = 235, 26.5%). Children with family history of asthma (n = 575) were significantly more likely to have a pet at home and exposure to STS (n = 347, 60.3% and n = 198, 34.4%, respectively) compared to families without a history of asthma (n = 124, 50%, p = 0.006 and n = 44, 17.7%, p < 0.001, respectively). Similarly, asthmatic children with exposure to STS (n = 241) were significantly more likely to have a pet at home and a family history of asthma (n = 153, 63.5% and n = 197, 81.7%, respectively) compared to children with no STS exposure (n = 315, 55.5%, p = 0.034 and n = 371, 65.3%, p < 0.001 respectively). Conclusions: Significantly more asthmatic children with immediate relatives with a history of asthma have a pet at home and experience STS exposure compared to children without relatives with a history of asthma, suggesting association between life style choices/environmental exposures and family history of asthma.

Improved quality-of-life of caregivers of children with asthma through guideline-based management

ABSTRACT Objective: The quality of life (QOL) of caregivers of children with asthma may be related to childrens responses to asthma management. Aim: To evaluate change in QOL over time of caregivers of children with asthma through guideline-based management. Design: This was a 3-year prospective cohort study of children with asthma referred to our pediatric asthma center. Families completed Pediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ), the Asthma Control Test™ (ACT), and reported the number of days/month of albuterol use and wheezing at each clinic visit. Results: We enrolled 143 children, ages 7–17 years (mean = 10.6 ± 2.9), 56.6% male, 70.6% Caucasian. Patients were managed by the same MD (n = 65,45.5%) or APN (n = 78,54.5%) over time. The mean total PACQLQ significantly increased over the 3-year period (F = 67.418, p < .001). Total scores at the first visit were 4.8 ± 1.6, which improved to 6.1 ± 1 at the 3-month follow-up visit. This improvement was sustained at the 1, 2, and 3-year clinic visits. PACQLQ emotional function (F = 60.798, p < .001) and activity limitation (F = 41.517, p < .001) domains significantly improved as well. PACQLQ scores were significantly associated with improved ACT scores (r = .37 to .47, p < .05), fewer days/month of albuterol use (r = −.25 to −.36., p < .05), and wheezing (r = −.28 to −.33, p < .05). There were no significant differences in PACQLQ, or asthma clinical outcome measures between MD and APN providers. Conclusion: Use of National Asthma Education and Prevention Program (NAEPP) guidelines significantly improved QOL of caregivers of children with asthma and in asthma-related symptoms. Improvements over time were independent of type of providers.

Role of Omalizumab in Children With Difficult to Control Asthma

Omalizumab is a humanized monoclonal antibody used in the treatment of moderate to severe allergic asthma in children over 12 years and adults. There are many adult studies that have shown it to be a safe drug. The adult clinical trials show improvement in clinical outcomes for patients on omalizumab but reports on its real-life use in children are few. Additional studies for the use of omalizumab in pediatric population are needed. The aim of this paper is to review the limited pediatric literature and compare with a retrospective chart review done for pediatric patients taking omalizumab at a tertiary pulmonary clinic with moderate to severe allergic asthma. A review of the recent pediatric studies was compared with a retrospective chart review on all patients prescribed Xolair (omalizumab) (n=13) between 2003 and 2010. The recent pediatric studies showed a reduction in prednisolone use, improvement of Asthma Control Test, improvement of Asthma Quality of Life Questionnaire, and clinically significant decrease in asthma exacerbations. In the retrospective review there was a clinically significant decrease in the number of hospital days and a trend in decrease of emergency room visits. There was no clinically significant difference in lung function. Adverse reactions were noted. The recent pediatric studies showed omalizumab improved overall health of children with asthma but more pediatric studies are needed.